Shome-Vasanthan Epsita, Chou Sophia, Hemmett Juliya, MacRae Jennifer, Ward David, Gallagher Nathen, Al-Wahsh Huda, Qirjazi Elena
Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.
Cumming School of Medicine, University of Calgary, AB, Canada.
Can J Kidney Health Dis. 2024 May 28;11:20543581241255784. doi: 10.1177/20543581241255784. eCollection 2024.
There is little evidence on the ideal frequency of routine blood work in maintenance dialysis patients to manage complications, including anemia, mineral bone disease (MBD), and hyperkalemia. Recent quality improvement studies from Ontario showed no negative impacts when decreasing the frequency from monthly to every 6 weeks in conventional in-center hemodialysis (ICHD) patients. In December 2020, Alberta Kidney Care-South (AKC-S) reduced the frequency of routine blood work from every 6 weeks to every 8 weeks for ICHD patients.
We aimed to assess the impact of reducing blood work frequency on patient outcomes.
We compared prevalent AKC-S ICHD patients in 2 cohorts: (1) retrospective control (October 31, 2019-October 31, 2020) and (2) prospective intervention (December 1, 2020-December 1, 2021). Primary outcomes were true frequency of routine blood work, odds of patients being within target for anemia and MBD, and proportion of lab values of hyperkalemia. Furthermore, we compared hospitalizations and mortality.
A total of 972 patients in Calgary's ICHD program were included, 787 in each period (with 602 patients overlapping both cohorts). The frequency of routine blood work decreased from every 39.5 days in the control period to every 54.2 days in the intervention period ( < .01). There was a reduction in the odds of phosphate values in targets ( = .02), and an increase in the odds of labs with hyperkalemia (>6.0 mmol/L) during the intervention period ( = .01). There was no significant change in the odds of being within the accepted targets during the intervention period compared with the control period for hemoglobin, Tsat, calcium, or parathyroid hormone (PTH). Fewer patients were hospitalized during the intervention period and the risk of death decreased as well, although additional factors such as the COVID-19 pandemic may have affected this. A cost-savings of $32 962 occurred from the reduced anemia and MBD blood work during the intervention period.
When ICHD units in Calgary reduced routine blood work frequency from every 6 weeks to 8 weeks, there were no negative impacts on hospitalizations or deaths. A slightly lower proportion of phosphate values were within target, and a 0.7% increase in potassium values greater than 6 mmol/L was demonstrated. Our study suggests that blood work frequency in ICHD dialysis patients may be further reduced to every 8 weeks safely. Ultimately, additional pragmatic trials are needed to identify the optimal frequency of routine blood work.
关于维持性透析患者进行常规血液检查以管理并发症（包括贫血、矿物质骨病（MBD）和高钾血症）的理想频率，证据很少。安大略省最近的质量改进研究表明，将传统中心血液透析（ICHD）患者的检查频率从每月降至每6周，没有负面影响。2020年12月，艾伯塔省南部肾脏护理中心（AKC-S）将ICHD患者的常规血液检查频率从每6周降至每8周。
我们旨在评估降低血液检查频率对患者结局的影响。
我们比较了两个队列中AKC-S的ICHD患者：（1）回顾性对照组（2019年10月31日至2020年10月31日）和（2）前瞻性干预组（2020年12月1日至2021年12月1日）。主要结局是常规血液检查的实际频率、贫血和MBD患者达到目标值的几率以及高钾血症实验室值的比例。此外，我们比较了住院率和死亡率。
卡尔加里ICHD项目共纳入972例患者，每个时期各787例（两个队列中有602例患者重叠）。常规血液检查频率从对照期的每39.5天降至干预期的每54.2天（P<0.01）。干预期内，达到目标值的磷酸盐值几率降低（P=0.02），高钾血症（>6.0 mmol/L）实验室值几率增加（P=0.01）。与对照期相比，干预期内血红蛋白、转铁蛋白饱和度、钙或甲状旁腺激素（PTH）达到可接受目标值的几率没有显著变化。干预期内住院患者减少，死亡风险也降低，不过诸如新冠疫情等其他因素可能对此产生了影响。干预期因减少贫血和MBD血液检查节省了32962美元成本。
当卡尔加里的ICHD单位将常规血液检查频率从每6周降至8周时，对住院率或死亡率没有负面影响。达到目标值的磷酸盐值比例略低，血钾值大于6 mmol/L的比例增加了0.7%。我们的研究表明，ICHD透析患者的血液检查频率可能可以安全地进一步降至每8周。最终，需要更多务实的试验来确定常规血液检查的最佳频率。
